Clavicle Fracture Malunion S42.009P 733.81

synonyms: colar bone fracture

Clavicle Fracture Malunion ICD-10

• S42.001P - Fracture of unspecified part of right clavicle, subsequent encounter for fracture with malunion
• S42.002P - Fracture of unspecified part of left clavicle, subsequent encounter for fracture with malunion
• S42.009P - Fracture of unspecified part of unspecified clavicle, subsequent encounter for fracture with malunion

Clavicle Fracture Malunion ICD-9

• 733.81  Malunion of fracture

Clavicle Fracture Malunion Etiology / Epidemiology / Natural History

• 4-15% of all fractures
• 2.6% of all fractures and 44% of those in the shoulder girdle. (Postacchini F, JSES 2002;11:452).
• Men (68%) > women (32%). (Postacchini F, JSES 2002;11:452).
• Left side (61%) > right side (39%). (Postacchini F, JSES 2002;11:452).
• Middle 1/2 fractures are the most common (81%), are displaced in 48% of cases and comminuted in 19%. (Postacchini F, JSES 2002;11:452).
• Traffic accidents are the most common cause in adults. (Postacchini F, JSES 2002;11:452).
• Occur in cycling and equestrian sports (inertia after a sudden stop throws rider forward landing on unprotected shoulder)

Clavicle Fracture Malunion Anatomy

• S shaped: anterolateral surface is concave, convex on anteromedial surface.
• First bone to ossify, 5^th gestational week
• Only long bone to ossify be intramembranous ossification
• Medial physis=80% of longitudinal growth
• Both acromial and sternal physes can remain open into 3^rd decade of life
• Middle 1/3 fractures typically heal with the lateral shaft fragment displaced posterior to the medial shaft fragment / anterior-posterior angulation. (Edleson JG, JSES 2003;12:173).
• Diameter of medullary canal is approximately 7mm at its narrowest point. (Andermahr J, Clin Anat 2006;20:48).
• See also Shoulder Anatomy.

Clavicle Fracture Malunion Clinical Evaluation

• Patients complain of; shoulder weakness, fatigue, paresthesias, cosmetic deformity, pain at rest or with activity, asymmetry.
• Pain over clavicle, crepitus.
• Ptosis of affected shoulder.

Clavicle Fracture Malunion Xray / Diagnositc Tests

• A/P view of clavicle and 30°-45º cephalic tilt view of clavicle.
• Apical oblique (Grashe with 20 cephalad)
• Abduction Lordotic (after ORIF)
• Serendipity view (helps with A/P displacement)
• Axillary
• Zanca 15 degree apical oblique (AC joint)

Clavicle Fracture Malunion Classification / Treatment

• Nonoperative: physical therapy, activity modifications, NSAIDs
• Operative: osteotomy with Clavicle Fracture ORIF 23515 +/- bone grafting. 

Clavicle Fracture Malunion Associated Injuries / Differential Diagnosis

• Clavicle fracture nonunion

Clavicle Fracture Malunion Complications

• Infection
• Neurovascular Injury
• Hardware failure (Brouwer KM, JSES 2008 IP)
• Sequelae of clavicle fractures: shoulder weakness, fatigue, paresthesias, cosmetic deformity, pain at rest or with activity, asymmetry.

Clavicle Fracture Malunion Follow-up Care

• Shoulder Outcome measures.

Clavicle Fracture Malunion Review References

• Orthopaedic Knowledge Update: Shoulder and Elbow, No. 3